HEALTH OUTCOMESMorbidity

33

Multiple Chronic Conditions

Ove

rwe

ight/O

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sity

Diab

etes

Preterm Births

Hypertension

Mental Health

Sen

ior Tsu

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Asth

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Chronic Obstructive Pulmonary Disease

SENIOR TSUNAMI

34

Community Health ImportancePeople are living longer because of both lifestyle changes and advances inhealthcare. The American Hospital Association reports that more people will beenjoying their later years, but they’ll be managing more chronic conditions andtherefore utilizing more healthcare services. Meeting these future healthcarechallenges will require more resources, new approaches to care delivery andgreater focus on wellness and prevention.

What led to this Health Outcome?America’s population is growing older and people are living longer. The babyboomers generation - people born between 1946 and 1964, started to turn 65 in2011, and 10,000 a day are added to the Medicare population.

Community AssetsCurrent community initiatives and organizationsthat provide senior services include: Elder Network; home health agencies;Olmsted County Community Services; Olmsted County Public Health Services;Rochester Senior Center; senior living options; and Southeastern MinnesotaArea on Aging.

Area of Greatest OpportunityStrategies to decrease falls among the 65 and older population could includeprevention programs focusing on both behavioral and environmentalcomponents. Older adults should be encouraged to participate in activityprograms that aim to increase strength and balance along with socialinteraction.

Definition The rapidly growing senior population has been referred to as a senior tsunami;named so because of the large number of baby boomers that are 'flooding' intothe senior population.

This assessment focuses on two metrics, through the Rochester EpidemiologyProject (REP): (1) falls - defined as the prevalence of falls among those 65 yearsand older that require medical attention; and (2) polypharmacy - defined as theproportion of those 65 years and older, who have been prescribed medication inmore than five prescription classes within a year.

Data SourcesAmerican Hospital Association; Centers for Disease Control and Prevention; Rochester Epidemiology Project; United States Census Bureau

Community Perception

Slight Moderate Significant Severe/Extreme

32% of prioritization participants feel senior tsunami is one of the top health issues impacting Olmsted County residents

Level of Threat/Issue

SENIOR TSUNAMI35

Health Disparities

FallsIn Olmsted County, female seniors have a higher rate of falls seeking medical attentionthan males (6.3% vs 5.4%). There are no notable differences seen between white, blackand Hispanic seniors; however, Asians experience fewer falls than whites (3.5% vs 6.0%).

PolypharmacyThere are no significant differences in polypharmacy between gender (female 58.6% vsmale 57.4%).

From 2012 to 2014, polypharmacy among all races has increased. During this time period,prevalence among black seniors and Hispanic seniors has increased the most (20.1% and22.0%, respectively).

HP2020

Trend Data with Goal

FallsThe Centers for Disease Control and Prevention reports that one out of three older seniors, 65 years and older, fall each year, but less than half tell their doctor. Datagathered from REP indicates that 6% of Olmsted County seniors were seen in hospitals, clinics or emergency departments for falls in 2014. As age increases, the rateof falls increase as well; seniors over 85 years have the highest prevalence of falls at 15%.

PolypharmacyData gathered from REP indicates that 58% ofOlmsted County seniors were prescribedmedication in more than five prescription groupsin 2014. The overall trend of polypharmacycontinues to increase, with a 9.5% increasebetween 2012 and 2014. As age increases, therate of polypharmacy increases as well; seniorsover 85 years have the highest prevalence ofpolypharmacy at 74%.

The top three prescribed medications contributing to polypharmacy include:

• Anti-depressants

• Anti-lipemic Agents

• Opioid Analgesics

5.9

0

1

2

3

4

5

6

7

2012 2013 2014

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Olmsted County Falls Prevalence (65+ Years) by Race

White Black Asian Hispanic Total

58.0

45

47

49

51

53

55

57

59

61

63

65

2012 2013 2014

Pe

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Olmsted County Polypharmacy Prevalence (65+ Years) by Race

White Black Asian Hispanic Total

OVERWEIGHT/OBESITY

36

DefinitionAdults are classified as overweight with a BMI* between 25.0 and 29.9; andobese with a BMI of 30.0 or higher. Children and adolescents are classified asoverweight with a BMI-for-age at the 85th to less than 95th percentile andobese with a BMI-for-age equal to or greater than 95th percentile.

This assessment focuses on local weight status assessed during the OlmstedCounty CHNA survey. Height and weight measurements were self-reported andself-perceived weight status was ascertained.

*BMI (body mass index) is a person's weight in kilograms divided by his or herheight in meters squared.

Data SourcesCenters for Disease Control and Prevention: Behavioral Risk Factor SurveillanceSystem, National Health and Nutrition Examination Survey; Healthy People2020; Minnesota Department of Health, Minnesota Student Survey; OlmstedCounty CHNA Surveys

Community Health ImportanceObesity is associated with many health-related problems from diabetes, heartdisease, hypertension, and premature mortality to mental health issues. Inaddition, obesity increases the overall cost of healthcare placed on society.

What led to this Health Outcome?Many factors are associated with overeating and inadequate exercise thatresults in obesity. Factors may include: lack of knowledge of caloric intake, lackof access to healthy foods, eating for psycho-social reasons, overfeeding byparents, or lack of safe places to exercise.

Community AssetsCurrent community initiatives andorganizations working toward decreasingoverweight/obesity include: Channel One Food Bank; Eat Smart, Be Smart(Rochester Community & Technical College); Farm to School programs; FarmersMarket expansions and the acceptance of Electronic Benefit Transfer; theregional Food Policy Council; Healthy Concessions (Mayo Field); Olmsted CountyPublic Health Services, Statewide Health Improvement Program (SHIP); WorksiteWellness; YMCA; and health clubs.

Area of Greatest OpportunityBecause weight is influenced by energy (calories) consumed and expended,interventions to improve weight can support changes in diet or physical activity.They can help change an individual’s knowledge and skills, reduce exposure tofoods low in nutritional value and high in calories, or increase opportunities forphysical activity. Improved access to healthy foods at schools, fast food sitesand in homes continues to be a local community goal.

Community Perception

Slight Moderate Significant Severe/Extreme

52% of prioritization participants feel overweight/obesity is one of the top health issues impacting Olmsted County residents

Level of Threat/Issue

OVERWEIGHT/OBESITY37

Trend Data with GoalAccording to the most recent national survey data available (Behavioral Risk Factor SurveillanceSystem, 2014), approximately 65% of United States and 64% of Minnesota adults are overweightand obese, with 29.6% and 27.6%, respectively being obese.

To measure self-perception of weight status, Olmsted County CHNA Survey respondents wereasked: ‘Do you consider yourself to be… underweight; about the right weight; or overweight?’Self-reported height and weight measurements were also assessed to calculate exact BMImeasurements. These results indicate that 45% believe they are currently overweight. This figurerises considerably when looking at BMI calculations - 41% of Olmsted County adults areoverweight; 28% are obese (with a total of 68% being overweight or obese).

Healthy People 2020 reports that 16% of adolescents age 12 to 19 are considered obese. The 2013Minnesota Student Survey shows that 17% of Olmsted County youth and adolescents considerthemselves to be overweight (13% males; 21% females). BMI calculations for these studentsshows that 18% are overweight or obese (22% males; 18% females).

HP2020

Health Disparities According to local data, obesity health disparities currently exist among certain subpopulationsthroughout Olmsted County. Those born in the United States; white, non-Hispanic individuals; andthose who currently rent their home are more likely to be overweight or obese.

*HP 2020 target is for adults 20 and older

DIABETES

38

DefinitionDiabetes mellitus is a metabolic disease in which the body’s inability to produceany or enough insulin causes elevated levels of sugar in the blood (glucose).

This assessment focuses on two metrics: (1) through the RochesterEpidemiology Project (REP), the prevalence of diabetes; and (2) Olmsted CountyCHNA Survey respondents were able to identify if they had been diagnosed withdiabetes.

Community Health ImportanceDiabetes affects an estimated 23.6 million people in the United States and is atop leading cause of death.

Diabetes impacts all aspects of a person’s life from requiring changes in eatinghabits and daily monitoring of glucose levels to increasing risk for many otherchronic conditions. The healthcare utilization and costs for people with diabetesare much higher than those for people without diabetes since many of thosewith diabetes are unable to follow the required life style changes and thereforehave uncontrolled blood sugars which result in higher rates of complications.

The rapid, often termed epidemic, increase in diabetes puts high demand onhealthcare services, including patient education, and forces the profession,including public health, to address the wide spread issues of low to modesthealth literacy. Because diabetes requires people to manage their condition ona day-to-day basis, it is imperative that they understand their condition and self-management goals and mechanisms.

What led to this Health Outcome?Currently type I diabetes is not preventable but treatable. Type II diabetes isclosely associated with obesity and has been increasing in frequency for the pastseveral years. Type II diabetes risk factors are a combination of geneticpredisposition and obesity. The relative importance of the two is unknown butpreventing obesity can delay or prevent the onset of type II diabetes.

Community AssetsCurrent community initiatives andorganizations that promote diabeteseducation, prevention and treatment include: Mayo Clinic Rochester; OlmstedMedical Center; Olmsted County Public Health Service, Statewide HealthImprovement Program (SHIP); medical and public health diabetes education;and home care agencies.

Area of Greatest OpportunityThe increase in type II diabetes in the adolescent and young adult populationand the recent Somalia immigrant population highlight the urgency of the needfor prevention - obesity prevention and treatment to prevent or delay diabetesonset.

Improving health literacy may be another major opportunity. By increasinghealth literacy it may be feasible to increase the number of people with diabeteswho can adequately self-manage their diabetes to prevent complications andneed for emergency room visits and hospitalizations. Establishing a diabetesprevention program in the community has also been identified as a priority.

Data SourcesCenters for Disease Control and Prevention: Behavioral Risk Factor SurveillanceSystem, National Health and Nutrition Examination Survey; Healthy People2020; Minnesota Department of Health, Health Improvement Division; OlmstedCounty CHNA Surveys; Rochester Epidemiology Project

Community Perception

Slight Moderate Significant Severe/Extreme

13% of prioritization participants feel diabetes is one of the top health issues impacting Olmsted County residents

Level of Threat/Issue

DIABETES39

Trend Data with GoalAccording to the Centers for Disease Control and Prevention (2014), 7.1% of the Olmsted Countypopulation has been diagnosed with diabetes; 7.5% in Minnesota and 9.3% in the United States.

Data gathered from REP indicates that approximately 13% of Olmsted County residents are currentlyliving with diabetes. The Olmsted County CHNA Community Survey indicates 10.2% of adults have beentold they are diabetic and an additional 4.1% have been told they are pre-diabetic. Local data shows aslight increasing trend over the last few years.

HP2020

Somali immigrants with several cases of new onset type II diabetes following arrival in the United States and changes in diet and exercise. Data gathered from REP indicates that 2014 diabetes prevalence in the black population is 55% higher than the white population (18.7% vs 12.1%, respectively).

REP data indicates that men in Olmsted County have higher rates of diabetes as compared to women(14.2% vs. 12.3%, respectively). Additionally, the highest diabetes prevalence is seen in the oldest agedcohort - adults 65 years of age and older - at 48.6%.

The Minnesota Department of Health recently reported that working-age adults (18-64) who live inhouseholds earning less than $35,000 a year are two-and-a-half times as likely to report havingdiabetes as those with incomes higher than $35,000. One in four adults in Minnesota have incomesbelow $35,000. Local survey data shows that three times more Olmsted County adults earning lessthan $35,000 have diabetes than those earning more.

According to local data, diabetes health disparities currently exist among certain subpopulationsthroughout Olmsted County. Those with poor or fair health status and those living in household earningless than $35,000 annually are more likely to have diabetes.

Health Disparities People from minority populations are more frequently affected by type II diabetes. Minority groups constitute 25% of all adult patients with diabetes in the United States and represent the majority of children and adolescents with type II diabetes. In Minnesota and the United States overall, diabetes risk is higher among African Americans. In Olmsted County that has been shown to be true for the recently arrived

MULTIPLE CHRONIC CONDITIONS

40

DefinitionPeople with multiple chronic conditions are those with two or more chronicdiseases that require treatment or are treatable. For example, an individualdiagnosed with heart disease and depression would be considered to beliving with multiple chronic conditions even though the conditions could allbe related to smoking.

This assessment focuses on two metrics: (1) prevalence of multiple chronicconditions, through the Rochester Epidemiology Project (REP); and (2)Olmsted County CHNA Survey respondents were asked to identify if they hadbeen diagnosed with a number of chronic conditions.

Community Health ImportanceMultiple chronic conditions is important to define and recognize sinceindividuals fitting this description have multiple requirements for lifestylechanges, multiple medications for therapy, and potentially multiple non-medication therapies. The conditions may provide greater than simpleadditive risk of complications and premature death.

Most adults over the age of 60 have multiple chronic conditions which cannegatively impact each other and make management of symptoms andprevention of complications difficult. This is one of the most importantproblems in the care of older adults.

What led to this Health Outcome?Genetics, environment and human behavior all affect the presence andfrequency of multiple chronic conditions and what those chronic conditionsare. Tobacco use and obesity are two major factors leading to the presenceof multiple chronic conditions, including cancer, heart disease, and diabetes.

Community AssetsWhile the community has many specialistswho deal with one disease or one organ system,people with multiple chronic condition require integration of these therapies.

Current community organization and initiatives that promote this integrationinclude: Mayo Clinic Rochester; Olmsted Medical Center; Olmsted CountyPublic Health Services; Zumbro Valley Mental Health Center; casemanagement; and electronic health management and sharing.

Data SourcesCenters for Disease Control and Prevention; Healthy People 2020; OlmstedCounty CHNA Surveys; Rochester Epidemiology Project

Area of Greatest OpportunityEfforts to assist lowering multiple chronic conditions should focus onpreventing and managing the most common conditions that contribute tomultiple chronic conditions. For Olmsted County that focus would includehyperlipidemia (high cholesterol), hypertension (high blood pressure) anddepression.

Community Perception

Slight Moderate Significant Severe/Extreme

10% of prioritization participants feel multiple chronic conditions is one of the top health issues impacting Olmsted County residents

Level of Threat/Issue

MULTIPLE CHRONIC CONDITIONS41

Trend Data with Goal Data gathered by REP indicates that approximately 28% of Olmsted County residents are living with twoor more chronic conditions. The highest prevalence is seen in seniors (65 years of age or older), with93.6% living with multiple conditions.

Data gathered from the Olmsted County CHNA Survey indicates that 33.4% of Olmsted County adultsare living with two or more chronic conditions.

Most Common Conditions Contributing

to Multiple Chronic Conditions (2 or more)

Condition %

Hyperlipidemia 18.3

Hypertension 15.6

Depression 12.0

Diabetes 11.1

Arthritis 9.8

Cancer 7.0

Arrhythmia 6.9

Asthma 5.6

Coronary Artery Disease

4.1

Substance Abuse 3.0

COPD 2.7

According to local data, health disparities currently exist among certain subpopulations throughoutOlmsted County. Those with fair or poor health status; those with no children in the household;retired individuals; and white, non-Hispanic individuals are more likely to have multiple chronicconditions.

Health Disparities REP data shows that more females are living with two or morechronic conditions than males (28.3% vs 23.3%, respectively).Additionally, white and black individuals have higher rates ofmultiple chronic conditions than Hispanic and Asian individuals(26.9%, 29.0% vs 24.0% and 22.3%, respectively).

MENTAL HEALTH

42

DefinitionMental illness refers to a wide range of mental health conditions - disordersthat affect your mood, thinking and behavior. Examples of mental illnessinclude depression, anxiety disorders, schizophrenia, eating disorders andaddictive behaviors. For children and adolescents this might include ADHD orADD as well as other disorders (oppositional disorders) that some considerunique to that age group and the developing brain.This assessment focuses on several mental health metrics assessed throughthe Rochester Epidemiology Project (REP) and the Olmsted County CHNACommunity Survey (Survey):• Mental illness prevalence via depression rates (REP) and self-reported

mental health conditions (Survey)• World Health Organization (WHO) Well-being Index• Accessing or delaying mental health care and reasons for delaying care

Refer to Supplemental Document, Appendix O for more information on thesemetrics.

Community Health ImportanceMental health is a state of successful performance of mental function,resulting in productive activities, fulfilling relationships with other people,and the ability to adapt to change and to cope with challenges. Mental healthis essential to personal well-being, family and interpersonal relationships,and the ability to contribute to community or society.

What led to this Health Outcome?While the community has many psychiatrists and psychologists, waiting timesfor appointments are long and insurance coverage is inadequate. Residentialfacilities for those who are chronically mentally ill are limited. Currentmental illness affects every aspect of a person and their family’s life fromability to complete family roles, roles within their house and community towork roles. For many, mental illness continues to be associated with stigmathat prevents discussion of the symptoms and may prevent seeking orreceiving appropriate and needed healthcare services.

Mental health problems in children andadolescents have both short term andpotentially long term consequences. Longterm, children and adolescents with emotional, developmental or behavioralproblems are less likely to attend college or trade school, less likely to holdfull time jobs, and more likely to spend time incarcerated. The costs of carefor these problems are significant and insurance coverage is often limited.

Community AssetsCurrent community initiatives and organizations working toward improvingmental health issues include: ABC Child and Family Therapy; BluestemCenter; Community Behavioral Health Hospital; Family and Children’s Center;Family Services Rochester; Fernbrook Family Center; Mayo Clinic Rochester,St. Mary’s Hospital; Minnesota Parents Know; National Alliance on MentalIllness (NAMI) SE MN; Olmsted County Adult Behavioral Health Unit:Assertive Community Treatment (ACT) Team, Certified Intensive DialecticalBehavior Therapy Program, Re-Entry Olmsted County, Rapid Access Clinic,Adult Rehabilitative Mental Health Services; Intensive CommunityRehabilitation Services Team; Olmsted County Children’s Mental HealthCollaborative; Olmsted County Public Health Services, Healthy Children andFamilies, Family Visiting Program; Olmsted County Children’s Mental HealthResource Center; Olmsted Medical Center; Y Resource Center; and ZumbroValley Mental Health Center.

Area of Greatest OpportunityThere is a need to increase community awareness about mental healthconditions in an effort to decrease the stigma that in many cases is thebarrier for reaching out for help. Access to mental health providers in ourcommunity is limited; advocacy and policy changes are needed to promotethe availability; and coordination of services is in urgent need.

Data SourcesCenters for Disease Control and Prevention, National Survey of Children’sHealth, 2007; Healthy People 2020; Minnesota Department of Health,Minnesota Student Survey; National Institute of Mental Health; OlmstedCounty CHNA Surveys; Rochester Epidemiology Project; World HealthOrganization

Community Perception

Slight Moderate Significant Severe/Extreme

67% of prioritization participants feel mental health is one of the top health issues impacting Olmsted County residents

Level of Threat/Issue

MENTAL HEALTH43

HP2020

Trend Data with Goal Data gathered from REP indicates that approximately 7% of Olmsted County adolescents and 16% of adultshad a depression diagnosis in 2014. There has been a 22% increase in depression prevalence in adolescentssince 2012 (5.8% vs. 7.2%); while depression in adults has remained stable. The Minnesota Student Surveyshows that 14% of Olmsted County and MN adolescents have considered committing suicide in the past.

Data from the Olmsted County CHNA Community Survey shows that 13.5% of residents scored 50 or belowon the World Health Organization’s (WHO) well-being index which indicates low mood; of these, 29.4%scored 28 or lower, which indicates depression is likely.

Local data also shows that nearly one in three people have ever had a mental health condition (29.2%);currently 32% of the population is living in a household with at least one individual with a diagnosed mentalhealth condition.

Over the last year, 12% of Olmsted County adults have seen a mental health provider for their own mentalhealth. Delaying care for mental health issues still exists. Overall, 5% stated they needed mental healthcarebut did not get it or delayed getting care. The top reasons for individual’s not getting or delaying care were:cost; didn’t know where to go; and work/family obligations. When all participants were asked why theybelieve people delay seeking care for mental health problems, the most common reasons were: afraid ofwhat others might think; cost too much; no insurance; did not know where to go; and not covered byinsurance.

Health DisparitiesData gathered from the REP depicts an80% higher prevalence of depression inadult females than males (20.8% vs11.6%). This is seen in the adolescentpopulation as well (9% female vs 5%males). The adult white population hasthe highest prevalence of depression(16.3%), followed by Hispanics (15.6%).In adolescents, Hispanics (8.5%) havethe highest prevalence followed bywhites (7.8%).

According to local data, mental healthdisparities currently exist among certain subpopulations throughout Olmsted County. White, non-Hispanicindividuals; those with fair or poor health status; financially stressed individuals; and those living inhousehold earning less than $35,000 annually are more likely to score below 50 on the WHO well-beingindex.

ASTHMA

44

DefinitionAsthma is a chronic inflammatory disorder of the airways characterized byepisodes of reversible breathing problems due to airway narrowing andobstruction. These episodes can range in severity from mild to lifethreatening. Symptoms of asthma include wheezing, coughing, chesttightness, and shortness of breath.

This assessment focuses on two metrics: (1) asthma prevalence, through theRochester Epidemiology Project (REP); and (2) Olmsted County CHNA surveyrespondents were asked to identify if they had ever been diagnosed withasthma.

Data SourcesCenters for Disease Control and Prevention, Behavioral Risk FactorSurveillance System and National Center for Health Statistics; Healthy People2020; National Institute of Health; Olmsted County CHNA Surveys; RochesterEpidemiology Project; United States Health and Human Services, NationalHeart, Lung and Blood Institute

Community Health ImportanceCurrently in the United States, more than 24 million people have asthma.The burden of respiratory diseases affects individuals and their families,schools, workplaces, neighborhoods, cities, and states. Because of the costto the healthcare system, the burden of respiratory diseases also falls onsociety; it is paid for with higher health insurance rates, lost productivity, andtax dollars. Annual healthcare expenditures for asthma alone are estimatedat $56 billion.

What led to this Health Outcome?Many asthma exacerbations result in emergency department visits andhospitalizations. Hospitalizations for asthma exacerbations are expensivemedical care undertakings, and are associated with missed school and workdays and adversely affect the patient’s quality of life.

Asthma can vary over time and is associated with exacerbations that have anacute onset and include a significant increase in symptoms. Most asthmaexacerbations are associated with an identifiable trigger, such asenvironment air pollution. The causes of asthma are complex, and involveboth genetic and environmental factors. Risk factors for asthma currentlybeing researched at a national level include: family history of asthma;sensitization to irritants and allergens; respiratory infections in childhood;and obesity.

Community AssetsCurrent community initiatives and organizations working around asthma include:Mayo Clinic Rochester; Olmsted County Public Health Services; Olmsted Medical Center; school districts; and Zumbro Valley Mental Health Center.

Area of Greatest OpportunityOpportunities to decrease asthma rates include policy and system-levelchanges: development of enhanced surveillance systems in cooperation withthe Minnesota Department of Health and all healthcare facilities; policiesrequiring all buses to stop idling if in place for more than 10 minutes andretrofitting all diesel-using buses to lower emissions.

Community Perception

Slight Moderate Significant Severe/Extreme

2% of prioritization participants feel asthma is one of the top health issues impacting Olmsted County residents

Level of Threat/Issue

ASTHMA45

Trend Data with GoalAccording to the latest Behavioral Risk Factor Surveillance System data (2014), 8.9% of thepopulation has asthma; 8.4% of Minnesota’s population currently has asthma.

Data gathered from REP indicates that 6.3% of Olmsted County residents currently have asthma; thispercentage would equate to approximately 7,950 individuals county-wide.

The Olmsted County CHNA Survey indicates that 14.6% of Olmsted County residents have ever beentold they had an asthma diagnosis.

Health DisparitiesAsthma affects people of every race, sex, and age. However, significant disparities in asthmamorbidity and mortality are known at a national level - in particular of low-income and minoritypopulations. These national disparities are consistently found in Olmsted County as well.

According to local data, asthma health disparities currently exist among certain subpopulationsthroughout Olmsted County. Those individuals not married; those living in households earning lessthan $35,000 annually; and non-retired individuals are more likely to have asthma.

HP2020

HYPERTENSION

46

DefinitionHypertension, or high blood pressure, is a disease which is associated with anincreased risk of heart disease and stroke.

This assessment focuses on two metrics: (1) prevalence of hypertension,through the Rochester Epidemiology Project (REP); and (2) Olmsted CountyCHNA Survey respondents were asked to identify if they had been diagnosedwith hypertension.

Community Health ImportanceAbout 70 million American adults (or approximately one in three adults),have high blood pressure. Only about half (52%) of people with high bloodpressure have their condition under control. High blood pressure increases asan individual ages. High blood pressure increases the risk for heart attack,stroke, heart failure, chronic kidney disease and cognitive decline.

Community AssetsCurrent community initiatives and organizationsworking around hypertension include: communityhealth fairs; Community Health Services; first responders (paramedics, firedepartment); home healthcare agencies; individual corporations with ahealthcare center; Living Well at Home in-home monitoring; Mayo ClinicRochester; Olmsted Medical Center; and pharmacies.

Area of Greatest OpportunityPreventing and managing hypertension shares similar strategies withdiabetes, obesity, physical activity, and fruit and vegetable consumption.Evidence-based strategies specifically for hypertension management focuson shifting to a holistic approach, including coordinating care and engagingpatients throughout their care.

What led to this Health Outcome?One in five adults with high blood pressure are undiagnosed. The exact causes of hypertension are not known, but several factors and conditions may play a role in its development, including:• Smoking• Being overweight or obese• Lack of physical activity• Too much salt in the diet• Too much alcohol consumption• Stress • Older age• Genetics• Chronic kidney disease• Adrenal and thyroid disorders • Sleep apnea

Data SourcesCenters for Disease Control and Prevention; Healthy People 2020; Olmsted County CHNA Surveys; Rochester Epidemiology Project Community Perception

Slight Moderate Significant Severe/Extreme

3% of prioritization participants feel hypertension is one of the top health issues impacting Olmsted County residents

Level of Threat/Issue

HYPERTENSION47

Trend Data with GoalData gathered from REP indicates that 17.5% of Olmsted County residents currently havehypertension. The Olmsted County CHNA Survey shows an even higher rate at 26.3%, whichis more in line with Minnesota at 27% and the United States at 31.4%.

Health DisparitiesAccording to REP data, Olmsted County males have a slightly higher prevalence ofhypertension than females (18.4% vs 16.7% respectively). Additionally, black individualshave the highest prevalence of hypertension (20.6%); Hispanic individuals have the lowestprevalence at 14.9%.

According to local data, hypertension health disparities currently exist among certainsubpopulations throughout Olmsted County. Retired individuals; those living in householdswith no children; and those with fair or poor health status are more likely to havehypertension.

HP2020

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

48

DefinitionChronic obstructive pulmonary disease (COPD), is a group of lung diseasesthat cause obstruction of the airways. Emphysema and chronic bronchitisare the two most common diseases that make up COPD. COPD is apreventable and treatable disease characterized by airflow limitation that isnot fully reversible.

This assessment focuses on two metrics: (1) prevalence of COPD, through theRochester Epidemiology Project (REP); and (2) Olmsted County CHNA Surveyrespondents were able to identify if they had been diagnosed with COPD.

Community Health ImportanceCOPD is the third leading cause of death in the United States. In 2013,approximately 149,205 individuals died from COPD - a number very close tothat reported for lung cancer deaths in the same year. In nearly eight out often cases, COPD is caused by exposure to cigarette smoke. In addition, otherenvironmental exposures (such as those in the workplace) may cause COPD.

What led to this Health Outcome?COPD is strongly associated with long-term tobacco smoking and is aprogressive disease that is often punctuated by recurrent exacerbationswhen symptoms rapidly increase and can deteriorate into symptomsrequiring hospitalization. Many COPD exacerbations have an identifiabletrigger; including: cigar smoke, secondhand smoke, pipe smoke, air pollutionand workplace exposure to dust, smoke or fumes.

Community AssetsCurrent community initiatives and organizations working around COPD include: Freedom to Breathe Act/Smoke Free Workplaces; Smoke Free Ordinances; and Smoke Free Multi-Unit Housing.

Area of Greatest OpportunityThere are several opportunities to advance knowledge regarding COPD and other respiratory disease conditions. Potential opportunities include efforts to enhance prevention, screening and detection, and community education.

Data SourcesCenters for Disease Control and Prevention, Morbidity and Mortality WeeklyReview, National Center for Health Statistics; Healthy People 2020; OlmstedCounty CHNA Survey; Rochester Epidemiology Project; United States Healthand Human Services, National Heart, Lung and Blood Institute

Community Perception

Slight Moderate Significant Severe/Extreme

No prioritization participants feel COPD is one of the top health issues impacting Olmsted County residents

Level of Threat/Issue

CHRONIC OBSTRUCTIVE PULMONARY DISEASE49

Trend Data with Goal Data gathered from REP indicates that 6.3% of Olmsted County residents, ages 50 and older, arecurrently living with COPD. The latest data from the Behavioral Risk Factor Surveillance System(2014) indicates that 6.4% of United States adults and 4.4% of Minnesota adults have COPD.

The Olmsted County CHNA Survey indicates that 3.4% of Olmsted County residents have been toldthey have a chronic lung disease, which includes COPD, chronic bronchitis or emphysema.

Health DisparitiesAt a national level, women and men are affected equally, yet more women than men have died ofCOPD since 2000. COPD is a disease that affects the older population; 6.3% of Olmsted Countyadults 50 years and older have COPD. This doubles when looking at the oldest group: 15% ofthose 85 years and older are living with COPD.

According to local data, COPD health disparities currently exist among certain subpopulationsthroughout Olmsted County. Those with fair or poor health status; individuals with no collegeeducation; retired individuals; and those living in household earning less than $35,000 annuallyare more likely to have COPD.

HP2020

PRETERM BIRTHS

50

Definition Preterm birth, or prematurity, is when an infant is born more than threeweeks early. This assessment focuses on infants born before full-term.

Data SourcesCenters for Disease Control and Prevention; Healthy People 2020; MinnesotaDepartment of Health, Center for Health Statistics

Community Health ImportancePremature birth is the biggest contributor to infant death. Babies whosurvive may spend weeks or months hospitalized in a neonatal intensive careunit and may face lifelong problems such as problems with learning; visionand hearing loss; feeding and digestive problems; respiratory problems;cerebral palsy; and/or autism.

What led to this Health Outcome?Even if a woman does everything 'right' during pregnancy, she still can have apremature baby, however certain risk factors can increase the chance that awoman will have a premature baby. Some of these risk factors include:previous preterm birth; being pregnant with more than one baby (twins,triplets, or more); problems with the uterus or cervix; chronic healthproblems in the mother, such as high blood pressure, diabetes, and clottingdisorders; certain infections during pregnancy; and cigarette smoking,alcohol use, or illegal drug use during pregnancy. Other factors associatedwith preterm birth are low or high age of mother; maternal race; lowincome; receiving late prenatal care; and stress.

Community AssetsCurrent community initiatives and organizations working toward decreasingpreterm births include: Birthright; March of Dimes; Mayo Clinic Rochester; Olmsted County Public Health Services; Olmsted Medical Center; Planned Parenthood; and United Way of Olmsted County.

Area of Greatest OpportunityIn March 2015, the Minnesota Department of Health released the InfantMortality Reduction Plan. One of the priority recommendations developedto reduce infant mortality was to reduce the rate of preterm births inMinnesota.

'Minnesota has some of the lowest infant mortality rates in the country, but itis not acceptable that American Indian and African American infants aredying at twice the rate of white infants. This plan underscores that, if we areto improve overall infant survival, we must do more to address the social andeconomic factors impacting infant mortality in Minnesota.'

- Health Commissioner Dr. Ed Ehlinger

Community Perception

Slight Moderate Significant Severe/Extreme

1% of prioritization participants feel preterm births is one of the top health issues impacting Olmsted County residents

Level of Threat/Issue

PRETERM BIRTHS51

Trend Data with GoalFrom 2010 to 2014, there were an average of 2,172 births to Olmsted County residents. For every 100 live births, approximately nine are born premature. Thisrate remains relatively consistent; from 2010 to 2012 the rate of premature births in Olmsted County stayed fairly stable.

From 2010 to 2014, Olmsted County’s rate of preterm births (8.7%) continues to be lower than Minnesota (9.8%) and the national Healthy People 2020 goal of11.4%.

Note: Comparisons to the United States cannot be made; beginning in 2014, the National Center for Health Statistics transitioned to a new standard forestimating the gestational age of a newborn.

Health DisparitiesIn Olmsted County, from 2010 to 2014, premature births to whites (8.0%) were 22.5% lower than Asians (9.8%) and 17.5% lower than blacks (9.4%). The group ofwomen 40 years and older currently have the highest rate of preterm births (11.9%); this is also the only subgroup that is higher than the current Healthy People2020 goal of 11.4%

HP2020